Rocha Viviane Zorzanelli, Rached Fabiana Hanna, Miname Marcio Hiroshi
Cardiopneumology Department at the Heart Institute (InCor), University of São Paulo Medical School Hospital (FMUSP), Sao Paulo, Brazil.
Fleury Medicina e Saúde, Grupo Fleury, São Paulo, SP, Brazil.
J Inflamm Res. 2023 May 24;16:2223-2239. doi: 10.2147/JIR.S276982. eCollection 2023.
Atherosclerosis is the biological basis of ischemic heart disease and ischemic stroke, the leading causes of death in the world. After decades of studies, the understanding of atherosclerosis has evolved dramatically, and inflammation has been recognized as one of the most relevant pillars in all phases of atherosclerotic disease. Nevertheless, only recently, the trial CANTOS, and subsequent outcome studies with colchicine, finally provided proof-of-concept evidence that anti-inflammatory therapies were able to reduce cardiovascular events with no influence on lipid levels. These landmark studies inaugurated an era of clinical and pre-clinical studies of immunomodulatory strategies focused on reduction of cardiovascular risk. Although there are promising results in the field, selection of the most appropriate immunomodulatory therapy and identification of patients who could benefit the most, are still enormous challenges. Further research is imperative before we can finally advance towards regular use of anti-inflammatory agents to reduce atherosclerotic events in our clinical practice.
动脉粥样硬化是缺血性心脏病和缺血性中风的生物学基础,而缺血性心脏病和缺血性中风是全球主要的死亡原因。经过数十年的研究,对动脉粥样硬化的认识有了巨大的发展,炎症已被公认为是动脉粥样硬化疾病各个阶段最相关的支柱之一。然而,直到最近,CANTOS试验以及随后使用秋水仙碱的结果研究,最终提供了概念验证证据,即抗炎疗法能够减少心血管事件,而对血脂水平没有影响。这些具有里程碑意义的研究开创了专注于降低心血管风险的免疫调节策略的临床和临床前研究时代。尽管该领域有令人鼓舞的结果,但选择最合适的免疫调节疗法以及确定最能从中受益的患者,仍然是巨大的挑战。在我们最终能够在临床实践中常规使用抗炎药物以减少动脉粥样硬化事件之前,进一步的研究势在必行。